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Pseudotumor cerebri

Symptoms mimic those of a brain tumor, but no tumor is present. Pseudotumor cerebri can occur in children and adults, but it's most common in obese women of childbearing age.

When no underlying cause for the increased intracranial pressure can be discovered, pseudotumor cerebri may also be called idiopathic intracranial hypertension.

The increased intracranial pressure associated with pseudotumor cerebri can cause swelling of the optic nerve and result in vision loss. Medications often can reduce this pressure, but in some cases, surgery is necessary.

Symptoms
Causes
Risk factors
Complications

Pseudotumor cerebri signs and symptoms may include:

Moderate to severe headaches that may originate behind your eyes and worsen with eye movement

Ringing in the ears that pulses in time with your heartbeat (pulsatile tinnitus)

Nausea, vomiting or dizziness

Blurred or dimmed vision

Brief episodes of blindness, lasting only a few seconds and affecting one or both eyes (visual obscurations)

Difficulty seeing to the side

Double vision (diplopia)

Seeing light flashes (photopsia)

Neck, shoulder or back pain

Related

Though you might first discuss your symptoms with your family doctor, he or she may refer you to a doctor trained in brain and nervous system conditions (neurologist) or eye conditions (ophthalmologist) for further evaluation.

To get the most from your appointment, it's a good idea to prepare. Here's some information to help you.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements you're taking.

Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information you get during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Preparing a list of questions to ask your doctor will help you make the most of your time together. For pseudotumor cerebri, some questions to ask your doctor include:

What is likely causing my symptoms or condition?

Other than the most likely cause, what are other possible causes for my symptoms or condition?

What kinds of tests do I need?

Is my condition likely temporary or chronic?

What is the best course of action?

What are the alternatives to the primary approach you're suggesting?

Would losing weight help my condition?

I have these other health conditions. How can I best manage them together?

Are there any restrictions I need to follow?

Should I see a specialist?

Is there a generic alternative to the medicine you're prescribing?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

Don't hesitate to ask any other questions that arise during your appointment.

The goal of pseudotumor cerebri treatment is to improve your symptoms and keep your eyesight from worsening. Your doctor may prescribe medications to control your symptoms.

If you're obese, your doctor will recommend weight loss. You may work with a dietitian to help with your weight-loss goals. Losing weight may improve your symptoms. Some people who are morbidly obese may benefit from weight-loss programs or gastric surgery to lose weight.

If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure may be necessary. Once you've had pseudotumor cerebri, you should have your vision checked regularly.

Medications

Glaucoma drugs. One of the first drugs usually tried is acetazolamide (Diamox), a glaucoma drug. This medication may reduce the production of cerebrospinal fluid. Also, it has been shown to improve symptoms in 47 to 67 percent of people.

Possible side effects include stomach upset, fatigue, tingling of fingers, toes and mouth, and kidney stones.

Migraine medications. Medications usually prescribed to relieve migraines can sometimes ease the severe headaches that often accompany pseudotumor cerebri.

Surgery

Optic nerve sheath fenestration. In this procedure, a surgeon cuts a window into the membrane that surrounds the optic nerve. This allows excess cerebrospinal fluid to escape.

Vision stabilizes or improves in most cases. Most people who have this procedure done on one eye notice a benefit for both eyes. However, this surgery isn't always successful and may even increase vision problems.